Provider Demographics
NPI:1457680050
Name:PEREZ, LAURA G (LMP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:G
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12117 KAPOWSIN HWY E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-7538
Mailing Address - Country:US
Mailing Address - Phone:253-847-2879
Mailing Address - Fax:
Practice Address - Street 1:12117 KAPOWSIN HWY E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-7538
Practice Address - Country:US
Practice Address - Phone:253-847-2879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60127153225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist